Abstract
A 75–year–old woman seen for increasing lower left abdominal pain 10 hours after onset had slight left lower abdomen tenderness, but no peritonitis. Contrast–enhanced computed tomography (CT) showed ileal wall thickening without enhancement and the superior mesenteric artery well–enhanced from the trunk to the peripheral region. Based on these findings and a preoperative diagnosis of nonocclusive mesenteric ischemia, we conducted emergency laparotomy 21 hours after onset. Ischemic changes were found in a 20–cm long region of the ileum starting 70 cm from the proximal end. Peripheral mesenteric congestion was present for 70 cm around the ischemic portion. Arteries within the mesentery were well palpable. We resection the ileum over the region of mesenteric congestion. Macroscopically, mucosa had segmentalized ischemia. Histologically, the ileum was hemorrhagically necrotic but mesentery vessels had no thrombosis. The postoperative course was uneventful and the woman was discharged on postoperative days 13.
